Late nights, poor sleep, and illnesses are all part of caring for an infant.

But what happens when a parent can’t afford to buy diapers?

That’s the situation for 1 in 3 families in the United States.

“Diaper need is when a parent or caregiver struggles to provide enough diapers to keep a baby or toddler clean, dry, and healthy. A hidden consequence of living in poverty,” Joanne Goldblum, CEO and founder of the National Diaper Bank Network (NDBN), told Healthline.

Diaper need is one of many consequences of living in poverty that’s not commonly discussed.

“Families and caregivers experiencing diaper need lack the money needed to provide clean diapers for their child, and often must choose between basic needs such as food, housing, utilities, or diapers,” Goldblum said.

A survey examining diaper need and its impact on American families was recently undertaken by the NDBN in association with Huggies.

The survey found that the 36 percent of families who report struggling with diaper need are falling short of 19 diapers each month.

Infants require up to 12 diapers per day. Toddlers require up to eight.

Disposable diapers cost $70 to $80 per month per baby. They can’t be purchased using food stamps.

The health effects

Not having enough clean diapers exposes a baby to many potential health risks.

“The primary health consequence of a dirty diaper, especially if a baby sits in it too long, is diaper rash. While this may not seem problematic, bad rashes can be very uncomfortable and skin breakdown can lead to bacterial infections of the skin,” Dr. Jaime Friedman, a pediatrician at the Children’s Primary Care Medical Group in California, told Healthline.

“If a diaper is not changed, it can become too full and leak,” Friedman added. “Leaked stool can contaminate surrounding areas and the bacteria in the stool can cause gastrointestinal infections in those who come into contact with the bacteria.”

How quickly a rash develops varies for each baby due to differences in skin type.

Friedman says a good rule of thumb is to change the diaper as soon as you know it’s dirty.

She says a diaper shouldn’t be left so that a baby urinates or has bowel movements multiple times in the same diaper.

Caregivers should look out for signs that suggest they may not be changing diapers frequently enough.

A foul odor from the diaper, skin irritation, severe diaper rash, leakage from the diaper, and a fussy child with poor mobility due to a full diaper are all signs the diaper should be changed more frequently.

Babies who remain in a dirty diaper for too long are also more susceptible to urinary tract infections (UTIs) as well as more frequent cases of diaper rash.

The NDBN survey found that 54 percent of respondents who reported experiencing diaper need took their children to the doctor to treat diaper rash.

Of those respondents, 1 in 4 took their child for treatment of diaper rash three or more times in the past year.

A hidden problem

Many families experiencing diaper need feel shame due to not having enough diapers.

In fact, 74 percent of those surveyed said they were embarrassed about not being able to afford diapers, and 80 percent agreed that people who are in need of diapers are hesitant to talk about it.

“I think parents who feel they cannot provide for their child would feel very stressed,” Friedman said. “I can’t imagine the shame and guilt a parent might feel having to ask for help with diapers. As pediatricians, we are tasked with assessing the mental health of the family and asking about food security. Perhaps diaper security should be added.”

“I would hate to see families rinsing diapers and reusing them. That can lead to poor sanitation and contamination of drinking water,” Friedman added.

“Plus, it would be very uncomfortable for the baby to be in a wet or full diaper, especially if they are trying to get up and start walking. A full diaper would get in the way. And then the subsequent rashes that can occur can create discomfort for the baby and stress for the parent,” she said.

The economic impact

As well as the negative health impacts on the baby, diaper need can also impact the physical, mental, and economic well-being of entire families.

The survey found that almost 3 in 5 parents — 57 percent — missed work or school in the past month because they didn’t have enough diapers when dropping off their children at day care, child care, or early education programs.

Most child care centers — even those that are free or subsidized — require caregivers and parents to provide a full day’s worth of diapers for their child.

“A lack of diapers to keep a baby clean can lead to economic hardship and high levels of stress in families striving to provide enough diapers and other necessities, including food, clothing, and housing,” Goldblum said.

Diaper need has also been linked to maternal depression. The stress of the situation is also thought to negatively impact the children in the home.

“The stress on the parent, who may be already stressed due to poverty, trickles down to infants and children,” Friedman said. “Toxic stress results from repeated adverse events or environment, and this includes mental health of the parent. Children exposed to toxic stress experience more ADHD and behavior problems.”

Raising awareness

Even though the NDBN and its diaper bank programs in communities across the country distributed more than 52 million diapers in 2016, 65 percent of the families surveyed said they weren’t aware of diaper banks.

Goldblum hopes that raising awareness of diaper need in the United States will encourage people who are experiencing diaper need to ask for help.

“When individuals and communities learn about diaper need, they want to help get clean diapers to all babies. When families in diaper need learn that resources exist in many communities that can help provide diapers for their children, they seek out assistance. While there are more than 300 NDBN-member diaper bank programs serving families throughout the U.S., far too many communities lack sustainable diaper distribution programs to meet the need fully,” she said.